Silent Giant Left Atrium: A Case Report

We report a case of a 34-year-old female with low-grade dyspnea on exertion despite markedly dilated left atrium (LA) on chest radiography which clouded our interpretation of the cause of enlarged cardiac silhouette. However, echocardiogram proved useful in demonstrating severe mitral stenosis and the giant LA.

Idiopathic Chylopericardium in a Young Adult: Diagnosis and Management

Primary idiopathic chylopericardium (PIC) is an uncommon cardiologic disorder; it is defined as accumulation of lymph in the pericardial sac without any know precipitating factor. A 25-year-old presented with dyspnea and chest pain for over two months. The patient underwent a chest X-ray, which revealed an enlargement of cardiac silhouette and signs of cardiac tamponade. Chest CT was performed, revealing large pericardial effusion and small pleural effusion on the right hemithorax. The patient was referred to the ICU and underwent a pericardial window through VATS, which revealed 500 ml of a milky fluid.

Surgical resection of a giant pericardial cyst: a case report

Background Pericardial cysts are rare congenital mediastinal cysts. They are typically asymptomatic and are often discovered incidentally, although some patients may present with chest pain and dyspnoea. Asymptomatic patients are managed conservatively with multiple modalities, with surgical resection often recommended for symptomatic patients only. The frequency of follow-up imaging has yet to be established. Case summary We report a case of a 59-year-old female with a gradually increasing pericardial cyst, first noted 10 years prior as an abnormal cardiac silhouette on routine chest radiography. Further evaluation confirmed the presence of a pericardial cyst compressing the left ventricle with new-onset atrial fibrillation. The patient underwent successful thoracoscopic excision of the pericardial cyst under general anaesthesia. The patient’s post-operative course was uneventful, and she was ultimately discharged in stable condition. Discussion Pericardial cysts are typically benign, but complications may arise in the case of compression of adjacent cardiac structures, inflammation, haemorrhage, or rupture of the cyst. Magnetic resonance imaging is considered the better modality for both diagnosis and follow-up of pericardial cysts. This case illustrates the need for long-term clinical follow-up in order to optimize the time for treatment.

Radiographic Measurements of the Cardiac Silhouette and Comparison with Other Radiographic Landmarks in Wild Galahs (Eolophus roseicapilla)

Background: Part of the diagnostic workup for cardiac diseases is radiographic imaging. To determine an enlarged heart, species-specific reference values are necessary. Wild birds are rarely diagnosed with cardiac disease, and only a few studies have been done to investigate the cardiac silhouette in wild birds. Methods: In this retrospective study, the cardiac silhouette of 36 wild galahs, presented at the hospital, was investigated in relation to other anatomic landmarks like the thoracic width, clavicula width, synsacrum width, distance between the third and fourth rib, distance of the clavicula, and length and height of the sternum using a digital DICOM viewer. Results: The cardiac width was significant compared to the thoracic width with a minimum to maximum of 50 to 65%. The cardiac width compared with the coracoid width also showed significant results with a minimum to maximum range of 570 to 743%. A significant correlation was found between the weight and the cardiac width and length. Conclusion: The cardiac silhouette in wild galahs is easily measured in both radiographic views, and the heart size can be compared to other anatomical landmarks.

Pericardial Access Through the Right Atrium in a Porcine Model

As procedures such as epicardial ventricular ablation and left atrial appendage occlusion become more commonplace, the need grows for safer techniques to access the physiologic pericardial space. Because this space contains minimal fluid for lubrication, prevailing methods of pericardial access pose considerable periprocedural risk to cardiac structures. Therefore, we devised a novel method of pericardial access in which carbon dioxide (CO2) is insufflated through a right atrial puncture under fluoroscopic guidance, enabling clear visualization of the cardiac silhouette separating from the chest wall. We performed the procedure in 8 Landrace pigs, after which transthoracic percutaneous pericardial access was obtained by conventional means. All of the animals remained hemodynamically stable during the procedure, and none showed evidence of epicardial or coronary injury. The protective layer of CO2 in the pericardial space anterior to the heart facilitated percutaneous access in our porcine model, and the absence of complications supports the potential safety of this method.

A Retrospective Study Correlating Modified Radiological Chest Volume and ‎Vertebral Heart Score with Pulmonary Patterns in Dogs

Veterinary practices rely on the Vertebral Heart Score (VHS) to determine cardiac silhouette size. In addition to cardiac silhouette, pulmonary patterns are examined to determine if clinical signs such as coughing are of cardiac or respiratory origin. Concept of interpreting pulmonary patterns are based on the anatomical structure involved within the lung parenchyma to make assumptions of manifestation of diseases. Modified Radiographic Chest Volume (mRCV) and Vertebral Heart Score (VHS) were retrospectively evaluated for correlation with pulmonary patterns in dogs. Patient data and thoracic radiographs were obtained from the digital repository of selected veterinary clinics in Malaysia. Findings revealed that there are wide variations in VHS and are significantly associated with pulmonary patterns (p < 0.05). Mean VHS values of 10.5 ± 1.2, and variations in mean mRCV across breed (26.74 ± 16.71) were observed. The mRCV weakly correlated with VHS denoting that changes in cardiac sizes does not necessarily synergise with lung volume. Therefore, it is recommended to evaluate pulmonary patterns alongside VHS while interpreting thoracic radiographs for cardiorespiratory diseases.

Pre-implant screening guided by cardiac silhouette fluoroscopy: a way to increase eligibility for the subcutaneous implantable cardioverter-defibrillator: a case report

Background Suitability for the subcutaneous implantable cardioverter-defibrillator (S-ICD) depends on a pre-implant electrocardiogram (ECG) screening to ensure appropriate sensing of electrical cardiac signals. Screening is performed positioning electrodes guided by chest surface anatomical landmarks. Case summary We report a case of a patient with an initially negative conventional automatic screening for S-ICD, who underwent a modified screening guided by cardiac silhouette position, as seen under fluoroscopy, resulting in eligibility for the S-ICD. Discussion The S-ICD reduces endovascular infection risk, providing therefore a potentially safer alternative in patients with prosthetic valves. It might be reasonable to perform a pre-implant ECG screening guided by fitting the cardiac silhouette in the shock vector, as this modified screening position could increase eligibility in patients who may benefit from S-ICD therapy such as the one presented.

Safe treatment of congenital left atrial appendage aneurysm using lateral thoracotomy on a 3-year-old patient

Limited literatures report the management of congenital left atrial appendage aneurysm (LAAA) which is extremely rare. Chest X-ray firstly showed an enlarged left cardiac silhouette for a 3-year-old patient with pneumonia. Echocardiography and magnetic resonance imaging confirmed a large cyst attached to the left atrium. Aneurysmectomy was performed through lateral thoracotomy using step-by-step method and under the guidance of transoesophageal echocardiography. We aim to show the safety and efficacy of this approach applied to children associated with congenital LAAA.